title: Improvement of prognosis in patients with metastatic renal cell carcinoma and Memorial Sloan-Kettering Cancer Center intermediate risk features by modern strategy including molecular-targeted therapy in clinical practice.
abstract: OBJECTIVE
  To identify the patient subgroups benefitting the most from the modern strategy including molecular-targeted therapy among patients with metastatic renal cell carcinoma (mRCC) in clinical practice.
  
  
  METHODS
  Retrospective analysis of 144 patients with mRCC diagnosed between 1992 and 2011 at Kyoto University Hospital was conducted. Multivariate analysis using the Cox proportional hazards model was conducted to identify prognostic factors associated with overall survival (OS). Subgroup analysis was conducted to identify patients who benefitted the most from molecular-targeted therapy.
  
  
  RESULTS
  Independent factors associated with worse OS are: tumors of histological type other than clear-cell, decreased hemoglobin (Hb), elevated lactate dehydrogenase (LDH), elevated C-reactive protein (CRP), and metastases at ≥ 3 sites. Median OS of patients treated with molecular-targeted therapy alone or with prior immunotherapy and those treated with immunotherapy alone was 57, 45 and 28 months, respectively. Molecular-targeted therapy had more effect on OS than immunotherapy alone among female patients, patients with Memorial Sloan-Kettering Cancer Center (MSKCC) intermediate risk features, and patients with metastatic progression less than 1 year after initial diagnosis of RCC, compared with their counterparts.
  
  
  CONCLUSIONS
  The modern strategy including molecular-targeted therapy may improve OS in patients with mRCC and MSKCC intermediate risk features in clinical practice, relative to those with other risk features. However, the prognosis for patients with tumors of histological type other than clear-cell, decreased Hb, elevated LDH, elevated CRP, or metastases at ≥ 3 sites remains poor even in the modern molecular-targeted era. Novel treatment strategies are necessary to improve prognosis in these patients.
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 6068507, Japan, kamba@kuhp.kyoto-u.ac.jp.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kamba
authors.forename: Toshinari
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Noboru
authors.initials: N
authors.lastname: Shibasaki
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Arakaki
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Okubo
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase